title: Retrospective study to identify predictors of the presence and rapid progression of aortic dilatation in patients with bicuspid aortic valves.
abstract: BACKGROUND
  Aortic dilatation is common among adults with bicuspid aortic valves (BAV). Predictors of risk and progression of aortic dilatation are not well described in this setting.
  
  
  METHODS
  We analyzed retrospective data on the presence of dilation in several aortic segments in 156 adult patients with BAV who had serial echocardiograms performed at least 1 year apart. Various risk factors for the presence and progression of aortic dilatation were identified.
  
  
  RESULTS
  Mean echocardiographic follow-up was 3.8 +/- 1.4 years, yielding a total of 582 patient-years. Independent predictors of having a dilated aorta at baseline were age (odds ratio [OR] 1.06, 95% CI 1.03-1.09), body surface area (OR 8.78, 95% CI 1.08-71.70) and moderate to severe aortic regurgitation (OR 6.38, 95% CI 2.51-16.20). During echocardiographic follow-up, 16 (15.2%) patients developed dilatation (incidence 4 cases per 100 patient-years). Mean annual rates of progression were estimated at 0.37 mm (95% CI 0.17-0.57), 0.18 mm (95% CI 0.05-0.31), 0.17 mm (95% CI 0.06-0.29) and 0.18 mm (95% CI 0.05-0.31) for the ascending aorta, sinotubular junction, aortic sinus and aortic annulus, respectively. Fusion of the right and left valve leaflets was associated with rapid aortic dilatation (OR 2.92, 95% CI 1.15- 7.41) whereas prior coarctation repair was associated with protection from rapid aortic dilatation (OR 0.13, 95% CI 0.04-0.40).
  
  
  CONCLUSIONS
  Patients with BAV and increased age, high body surface area and moderate to severe aortic regurgitation are more likely to have a dilated aorta. Patients with right-to-left leaflet fusion are at increased risk of rapid aortic dilatation.
authors.affiliation: Division of Cardiology, McGill University, Montreal, QC, Canada. george.thanassoulis@mail.mcgill.ca
authors.forename: George
authors.initials: G
authors.lastname: Thanassoulis
authors.forename: James W L
authors.initials: JW
authors.lastname: Yip
authors.forename: Kris
authors.initials: K
authors.lastname: Filion
authors.forename: Michal
authors.initials: M
authors.lastname: Jamorski
authors.forename: Gary
authors.initials: G
authors.lastname: Webb
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Siu
authors.forename: Judith
authors.initials: J
authors.lastname: Therrien
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging; D001830:Body Surface Area; D004108:Dilatation, Pathologic; D018450:Disease Progression; D018618:Echocardiography, Doppler, Color; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult